CLinical Pharmacy Manual 7th semester new.docx

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1. Pharmacy Practice-VA
(Clinical Pharmacy-I) Lab
PH4851
LAB MANUAL
7
th
SEMESTER
Capital University of Science and Technology
Islamabad Expressway, Kahuta Road, Zone-V, Islamabad
Phone: [phone], Fax: [phone]
Email: [email protected], Website: http//www.cust.edu.pk
Faculty of Pharmacy
Capital University of Science and Technology,
Islamabad

2. 1.Comparative CBC in Anemic Patients
Enroll several patients with anemia; perform CBC + reticulocyte count + peripheral smear;
compare patterns (microcytic / normocytic / macrocytic) and correlate with iron studies.
2.Electrolyte Abnormalities in Patients with Kidney Disease
Collect serial serum electrolytes (Na, K, Cl, HCO ) in CKD patients; document trends, identify
₃
common disturbances, relate to symptoms and medications.
3.Evaluation of Liver Function Tests in Acute vs Chronic Liver Disease
Take patients with acute hepatitis vs chronic liver disease; measure ALT, AST, ALP, GGT,
bilirubin, albumin, PT/INR; compare and interpret differences; document clinical correlates.
4.Urinalysis + Renal Function in Diabetic Patients
Monitor diabetic patients; do urinalysis (dipstick + microscopy), serum creatinine/BUN/eGFR,
proteinuria; examine correlation of glycemic control with renal damage.
5.Thyroid Function and Hematologic Changes
Collect TFTs (TSH, free T4/T3) in patients; simultaneously work up CBC; assess whether
hypothyroidism or hyperthyroidism correlates with anemia or RBC changes.
6.Effect of Dehydration on Serum Electrolytes and Renal Function
Study patients with acute dehydration (e.g. gastroenteritis); test before and after rehydration; see
how electrolytes/creatinine/eGFR change.
7.Drug-induced Liver Injury Case Study
Identify patient suspected of having drug-induced liver damage; document timeline, LFTs
before/during/after exposure; elimination of other causes; outcome.
8.Macrocytic Anemia Case Series
Patients with MCV >100 fL; measure B12, folate, liver function, thyroid; create case series
showing different etiologies (dietary deficiency, liver disease, alcoholism).
9.Acute Kidney Injury (AKI) vs Chronic Kidney Disease (CKD) Comparison
Compare lab values (creatinine, BUN, eGFR, electrolyte derangements) and urinalysis between
AKI and CKD patients; document patterns.

3. 10.Hyponatremia Causes & Management
Case study of patients with low sodium; work up underlying causes (SIADH, dehydration,
kidney disease, medications); document lab tests, treatment, outcomes.
11.Hyperkalemia in Hospitalized / ICU Patients
Identify patients with elevated potassium; check ECG, kidney function, medications; analyze
causes, management steps; document change in labs.
12.Serum Electrolytes & Acid-Base in Respiratory Disease
In patients with COPD exacerbation or asthma, measure ABG + serum electrolytes; see how
acid/base disturbances correlate; document compensation.
13.Urinalysis in Suspected Urinary Tract Infection (UTI)
Patients with UTI symptoms; collect midstream urine, dipstick + microscopy + culture;
document lab findings vs symptoms vs treatment response.
14.Evaluation of Coagulation Profiles in Liver Disease
Patients with chronic liver disease; measure PT, INR, aPTT, platelet count; document bleeding
risk, correlation with liver synthetic function.

4. CASE :01
DEPARTMENT ASSIGNED: Medical Ward 3
(Male/Female)
DEMOGRAPHICS:
Name: Tahira bibi Gender: Female
Age: 60 years Allergies:Nil
Consultant: Dr. Sana (Medical Unit-II) D.O.A: 19-09-25
VITALS:
Vital Signs on Adm ParameterValue Interpretation
Bp 90/60 mmHg Hypotension due to
dehydration and low blood
volume.
Pulse 102 bpm Reflex tachycardia due to
hypotension.
Respiratory Rate 20/min Normal; mild exertional
dyspnea due to anemia.
SpO
₂
96% Normal oxygenation; no
respiratory compromise.
Temperature Afebrile No active infection.
CHIEF COMPLAINTS:
Chief Complaints Reason:
Weakness and fatigue for 2 weeks Weakness and fatigue → due to low
hemoglobin (anemia) reducing oxygen
delivery to tissues.
Facial and periorbital puffiness for 3 daysFacial puffiness → due to fluid retention
from reduced renal perfusion.

5. Vomiting and decreased urine output for 2
days
Vomiting and low urine output → signs of
dehydration and possible renal involvement
PAST MEDICAL HISTORY:
Condition Duration Pathophysiology
DM (Type 2) 12 years Chronic disease affecting blood
vessels, kidney function, and
RBC production.
Hypertension 8 years Long-standing HTN may reduce
renal perfusion, leading to kidney
stress.
Recent Dengue Fever 3 weeks prior Transient bone marrow
suppression → reduced RBC
production.
Acute Gastroenteritis1 week oror Vomiting, dehydration,
electrolyte loss
PREENT SYMPTOMS:
Symptom Observation Possible Cause
Pallor Present Due to low Hb (8 g/dL) →
decreased RBCs → anemia
Facial/Periorbital Edema
Present
Fluid retention secondary to
pre-renal kidney impairment
Fatigue Constant Low Hb → poor oxygen
supply to muscles shortness
of BreathOn exertion
Anemia reduces
oxygen-carrying capacity

6. COMORBIDITIES:
DM.

Hypotension

Post Dengue
DIAGNOSTIC TESTS PERFORMANCE :
Lab Value interpretation
Diagnostic testsFindings
1.CBC Complete blood count
2.RFTS Creatinine, Urea, Electrolytes
3.LFTS ALT, AST, Bilirubin
4.URE R/E
Lab Value Interpretations:
Tests Value with unitsInterpretation Correction
Blood Test
Erythrocytes (RBCs)
Reticulocytes
Hematocrit
Hemoglobin (Hb)
Sedimentation rate (ESR)
Mean corpuscular volume (MCV)
Leukocytes - Total
Differential: Neutrophils
Lymphocytes
Monocytes
Eosinophils

7. Basophils
Platelet count
Diabetes Related
Glucose (fasting) (plasma or serum)
Glucose (Random) (plasma or serum)
HbA1c
LFTs
Albumin (serum)
Bilirubin (serum)
Transaminase (serum) -- AST
(SGOT)
ALT (SGPT)
Phosphatase, alkaline (serum)
Coagulation Tests
aPTT
Bleeding time (Ivy)
INR
Prothrombin time (PT)
Thrombin time (plasma)
Partial thromboplastin time (PTT)
Lipid Profile
High density lipoproteins (HDL)
Triglycerides
Low density lipoproteins (LDL)
(recommended range)

8. Cholesterol (serum)
Serum Electrolytes
Sodium (serum or plasma)
Potassium (serum)
Chloride (serum)
Calcium (serum)
Magnesium (serum)
Iron (serum)
Bicarbonate (HCO3) (serum)
Phosphate
Blood Gases
pCO2 (arterial)
pH (arterial)
pO2 (arterial)
Hormones
Thyroid-stimulating hormone (TSH)
Thyroxine, total (T4) (serum)
Thyroxine, free (FT4) (serum)
Triiodothyronine, total (T3) (serum)
Triiodothyronine, free (FT3) (serum)
Parathyroid hormone (PTH)
Prostate specific antigen (PSA)

9. Renal Function Tests
Creatinine (serum)
Urea (plasma or serum)
Urea nitrogen (BUN)
Uric acid (serum)
Urine Tests
Protein (urine)
Specific gravity
RBCs
Puss Cells
Color
pH
Final Comments
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10. CBC Data Collection
Details / Notes
Patient Name
Patient ID / Medical Record No.
Age Years (if child, include months)
Sex M / F / Other
Weight / Height / BMI Useful for contextualizing (e.g. dilutional changes)
Ethnicity / Background (if relevant for reference intervals)
Relevant Medical History /
Comorbidities
e.g. anemia, kidney disease, bleeding disorders, malignancy,
infection, chronic disease
Medications / Recent Treatments
Especially those affecting blood (chemo, erythropoietin, iron
supplements, etc.)
Recent symptoms Fatigue, pallor, fever, bruising/bleeding, weight loss, infections
Recent blood transfusions /
blood loss
Date & volume if known
Nutrition status / dietary historye.g. vegetarian / iron / B12 intake etc.
Parameter Result Reference
Range (Adult) *
Units Remarks / Comments
Red cell / oxygen
‐
carrying
RBC count ____Male: 4.3-5.9
×10¹²/L; Female:
3.5-5.5 ×10¹²/L
×10¹²/L
Hemoglobin (Hb) ____Male: ~13.5-17.5
g/dL; Female:
~12.0-16.0 g/dL
g/dL Severity, compare with
symptoms
Hematocrit (Hct) ____Male: ~41-53%;
Female: ~36-
46%
% Also gives info on
volume / RBC mass
Mean Corpuscular
Volume (MCV)
____80-100 fL fL Microcytic / macrocytic
classification
Mean Corpuscular
Hemoglobin (MCH)
____~27-31 pg per
cell
pg Hemoglobin per RBC
Mean Corpuscular
Hemoglobin
Concentration (MCHC)
____~32-36 g/dL g/dL Hemoglobin
concentration in RBCs
Red Cell Distribution
Width (RDW)
____~11.5-15% % Anisocytosis; early
deficiency etc.

11. White blood cells /
immune cells
WBC total count ____~4.5-11.0 ×10 /L
⁹
(i.e. 4,500-
11,000 /µL)
×10 /L or
⁹
cells/µL
Elevated in infection,
leukemia; low in
immunodeficiency etc.
Neutrophils (absolute /
% )
____ /
____
~2,500-7,000 /µL
OR ~50-70% of
WBC (varying
labs)
cells or
%
Neutrophilia /
neutropenia etc.
Lymphocytes (abs / %)____ /
____
~1,000-4,800 /µL
OR ~20-40%
cells or
%
Viral infection,
immunologic states etc.
Monocytes (abs / %)____ /
____
~200-1,000 /µL
OR ~2-8%
cells or
%
Chronic inflammation
etc.
Eosinophils (abs / %)____ /
____
~0-500 /µL OR
~1-4%
cells or
%
Allergic, parasitic etc.
Basophils (abs / %)____ /
____
~0-300 /µL OR
~0-1%
cells or
%
Rare; sometimes in
myeloproliferative
disorders
Platelets / Clotting
Platelet count ____~150-400 ×10 /L
⁹
(i.e. 150,000-
400,000 /µL)
×10 /L
⁹
Thrombocytopenia /
thrombocytosis etc.
Mean Platelet Volume
(MPV)
____~7.0-9.0 fL fL Platelet size; young
platelets etc.
Other indices (if
available – e.g.
Immature Platelet
Fraction, Reticulocyte
count)
____Lab-specific Useful in marrow
response etc.

12. LFT’s Data Collection
Section Field Notes / Instructions
Patient
Identification
Patient Name Full name
Patient ID / Medical
Record No.
Unique identifier
Age Years (if child, give months)
Sex M / F / Other
Weight / Height / BMIUseful for certain diagnoses (fatty liver, etc.)
Ethnicity / Background(optional)
Clinical HistoryReason for test /
Indication
e.g. routine screening, suspected hepatitis,
monitoring drug therapy, transplant follow-
up, etc.
Symptoms Jaundice, dark urine, abdominal pain,
pruritus, fatigue, nausea, etc.
Onset / Duration When did symptoms begin, chronic vs acute
Alcohol use Frequency / amount
Medications / Herbal /
OTC
Especially hepatotoxic drugs, supplements
Past liver disease /
Viral hepatitis
(HBV, HCV, etc.)
Risk factors Obesity, metabolic syndrome, exposure
(toxins), family history, travel etc.
Other comorbiditiesDiabetes, cardiac disease, renal, autoimmune,
etc.
Physical Exam
Findings
Signs of liver diseaseE.g. jaundice, hepatomegaly, splenomegaly,
ascites
Other findings Skin changes, signs of chronic liver failure,
etc.
Specimen / Sample
Info
Date of blood drawdd/mm/yyyy
Time of draw HH:MM
Fasting status Yes / No / Time since last meal
Label / CollectorName / initials
Any sample issue Hemolysis / lipemia / delayed transport / etc.
Laboratory
Results
Test Result
Alanine transaminase
(ALT)
____
Aspartate transaminase
(AST)
____
Alkaline phosphatase
(ALP)
____
Gamma-glutamyl ____

13. transferase (GGT)
Total bilirubin ____
Direct (conjugated)
bilirubin
____
Albumin ____
Total Protein ____
Prothrombin Time (PT)
/ INR
____
Lactate Dehydrogenase
(LDH)
____
Other tests (if ordered)____
Interpretation /
Pattern
Pattern detected Hepatocellular / Cholestatic / Mixed / Normal
Severity Mild / Moderate / Marked (× upper limit
normal)
Possible causes Based on clinical + lab (e.g. viral, alcohol,
drug-induced, biliary obstruction, NAFLD)
Plan / Next StepsFurther tests e.g. ultrasound, viral hepatitis panel, imaging,
biopsy, etc.
Treatment suggestionse.g. stop offending drug, refer hepatology,
lifestyle / diet / alcohol abstinence etc.
Follow-up When to repeat LFTs; monitor synthetic
function; check complication markers
Date of Report /
Signature
Date Of final review / report
Reviewed by Physician / Lab specialist
Typical Reference Ranges (Adult) — For your template
Test Normal Range (Approximate, Adult)
ALT ~0-45 IU/L
AST ~0-35 IU/L
ALP ~30-120 IU/L
GGT ~0-30 to 50 IU/L
Total Bilirubin ~0.1-1.2 mg/dL (≈2-17 µmol/L)
Direct Bilirubin~0-0.3-0.4 mg/dL
Albumin ~3.5-5.0 g/dL
Total Protein ~6.3-7.9 g/dL
PT / INR PT ~10.9-12.5 s / INR ~1.0 baseline

14. Serum Electrolytes Data Collection Template
Section Field Notes / Instructions
Patient InformationPatient Name Full legal name
Patient ID / MRN Medical record number or unique
identifier
Age In years (if child, include months)
Sex M / F / Other
Weight / Height / BMIUseful if body habitus might affect labs
(e.g. for hydration status)
Comorbidities &
Medications
Especially kidney disease, heart disease,
diuretics, steroids, laxatives, etc.
Symptoms / Indication for
test
E.g. muscle weakness, arrhythmia,
nausea/vomiting, edema, etc.
Recent intake / lossesVomiting, diarrhea, IV fluids, oral
intake, sweating, etc.
Specimen /
Collection Details
Date of draw dd/mm/yyyy
Time of draw HH:MM
Fasting or non-fastingNote if fasting required or not
Tube type / anticoagulant
used
E.g. serum tube, clot activator, etc.
Pre-analytic issues Hemolysis, lipemia, delay in
processing, difficult draw, etc.
Electrolyte ResultsElectrolyte Result
Sodium (Na )
⁺
____ ~135-145
Potassium (K )
⁺
____ ~3.5-5.5
Chloride (Cl )
⁻
____ ~97-106
Bicarbonate
(HCO ) / CO
₃ ₂⁻
content
____ ~22-29
Calcium (Total or
Ionized)
____ Total: ~8.8-10.7 mg/dL
Magnesium (Mg² )
⁺
____ ~1.3-2.6
Phosphate (Inorganic
phosphorus)
____ ~3.0-4.5
Optional / Additional
Tests
Anion gap ____
Serum osmolality ____
Other (e.g. ionized
magnesium, ionized
calcium)
____
Clinical ContextRenal function (Creatinine,____

15. BUN, eGFR)
Acid-base status (ABG if
done)
pH / CO / HCO etc
₂ ₃
Relevant medications /
recent treatments
List them
Hydration status / Volume
status
Dehydrated / Overhydrated / Normal
Interpretation /
Action
Pattern of electrolyte
imbalance
E.g. hyponatremia, hyperkalemia,
metabolic acidosis, etc.
Potential causes E.g. renal loss, GI loss, medications,
endocrine causes, etc.
Severity / Urgency Mild / Moderate / Severe; any critical
values that need urgent action
Recommended follow-up /
treatment
E.g. adjust fluids, stop or change
diuretic, administer electrolyte, refer
renal, etc.
Report Details Date of report dd/mm/yyyy
Reviewed by Doctor / Lab Specialist name &
signature
Common Reference Ranges (Adult) — For Electrolytes
Electrolyte Typical Adult Reference Range
Sodium (Na )
⁺
~135-145 mmol/L
Potassium (K )
⁺
~3.5-5.5 mmol/L
Chloride (Cl )
⁻
~97-106 mmol/L
Bicarbonate (HCO )
₃⁻
~22-29 mmol/L
Calcium (Total) ~8.8-10.7 mg/dL
Magnesium (Mg² )
⁺
~1.3-2.6 mg/dL
Phosphate ~3.0-4.5 mg/dL

16. Urinalysis & Renal Function Test Data Collection Template
Field Details / Notes
Patient Name
Patient ID / MRN
Age
Sex
Weight / Height / BMI
Relevant Comorbidities e.g. diabetes, hypertension, CKD, urinary tract disease, gout
Medications / SupplementsEspecially nephrotoxic drugs, diuretics, ACE/ARBs, NSAIDs
Hydration status / Recent fluid
intake or loss
Vomiting, diarrhea, IV fluids, etc.
Symptoms / Indication for
testing
e.g. dysuria, oliguria, edema, hematuria, flank pain, change in
urine output/color; routine monitoring
Duration of symptoms / acute
vs chronic
B) Specimen / Collection Details
Field Details / Notes
Date of collectiondd/mm/yyyy
Time of collectionHH:MM
Type of urine
specimen
e.g. first morning, random, mid-stream clean catch, catheter specimen
Fasting / non-fasting(if relevant to renal tests)
Transport / storage
time
Time from collection to lab; any delay?
Pre-analytic issues
noted
Hemolysis, sample contaminated, turbidity, delayed transport,
refrigeration or lack thereof
Parameter Resul
t
Reference (Normal) Range* Units /
Remarks

17. Physical / Appearance
Colour “Yellow (light to dark)”
Clarity / Turbidity Clear or slightly cloudy
Odor Aromatic / normal smelling
Chemical / Dipstick
pH ~5.0-8.0
Specific Gravity ~1.005-1.030
Protein Negative or trace
Glucose Negative or trace
Ketones Negative or trace
Blood / Hemoglobin Negative or trace
Bilirubin Negative
Urobilinogen 0.2-1.0 mg/dL
Nitrite Negative
Leukocyte Esterase Negative or trace
Microscopic / Sediment
RBC / HPF ~0-3 / HPF (males) / ~0-3-5
(depending on lab)
WBC / HPF ~0-5 / HPF
Epithelial Cells (Squamous /
Transitional / Renal Tubular)
Squamous ~0-9 / HPF; others
typically very low/absent
Casts (types: hyaline, RBC,
WBC etc.)
Hyaline up to small number in
LPF; RBC/WBC casts = none
normal
Crystals None / occasional (depending on
pH, solutes)
Bacteria / Yeast None in clean catch; “negative”
Renal Function Tests — Blood / Serum / Calculated Tests
Test ResultReference Range* Units Interpretation /
Remarks
Serum Creatinine ~0.6-1.3 mg/dL
(men) / ~0.5-1.1
mg/dL (women)
mg/dL Elevated suggests
impaired filtration;
consider muscle mass
etc.
Blood Urea
Nitrogen (BUN)
~7-20 mg/dL (some
variation)
mg/dL Elevated in renal
dysfunction /
dehydration / high
protein load etc.
BUN : Creatinine
Ratio
~10:1-20:1 (approx) Ratio Helps differentiate pre-
renal, intrinsic, post-
renal causes.

18. eGFR (estimated
Glomerular
Filtration Rate)
≥90 mL/min/1.73m²
(normal)
mL/min/1.73
m²
Lower values indicate
degree/stage of CKD.
Urine Albumin-
Creatinine Ratio
(uACR)
<30 mg/g (normal);
≥30 may indicate
kidney damage
mg albumin / g
creatinine
Early marker of kidney
damage.
Electrolytes
related to renal
function
(optional)
Varies per lab e.g. Na , K ,
⁺ ⁺
Cl etc.
⁻
For assessment of
tubular handling or
electrolyte disorders.
Field Details / Notes
Serum / Plasma
Electrolytes
Sodium, Potassium, Chloride, Bicarbonate etc.
Other blood tests CBC, Calcium, Phosphorus, Magnesium, (if indicated)
Imaging studies Renal ultrasound, CT scan etc., if suspected obstruction, stones
etc.
Past renal function labsPrevious creatinine, eGFR or BUN to assess trend / chronicity
Urine output Volume, frequency, nocturia, oliguria/anuria etc.
Item Details
Key Abnormal
Findings
Summarize what is abnormal (e.g. proteinuria, hematuria, elevated
creatinine, reduced eGFR etc.)
Likely Causes /
Differential Diagnosis
Pre-renal (dehydration), intrinsic (glomerular disease, tubular
disease), post-renal (obstruction), infection, etc.
Clinical SeverityMild / moderate / severe; urgent vs non-urgent findings
Suggested Next StepsRepeat test; imaging; refer nephrology; check for autoimmune or
infective causes; adjust medications; manage fluid/electrolytes etc.
Follow-up Testing PlanWhen to repeat labs; what additional tests if things don’t improve or
worsen

20. Dose & Disease Management
Case #: ___________ Diagnosis: ___________________________
Age: ___________ Gender: ___________________________
Medication History:
S.NoDrug Prescribed DoseFrequencyCalculated
dose
Justification of drug

21. Disease Management Notes
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22. Paediatric-I: Lab Value, Dose Calculation, Patient Profile
Case #: ___________ Diagnosis: ___________________________
Age: ___________ Gender: ___________________________
Lab Value Interpretations:
Tests Value with unitsInterpretation Correction
Blood Test
Erythrocytes (RBCs)
Reticulocytes
Hematocrit
Hemoglobin (Hb)
Sedimentation rate (ESR)
Mean corpuscular volume (MCV)
Leukocytes - Total
Differential: Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Platelet count
Diabetes Related
Glucose (fasting) (plasma or serum)
Glucose (Random) (plasma or serum)
HbA1c
LFTs

23. Albumin (serum)
Bilirubin (serum)
Transaminase (serum) -- AST
(SGOT)
ALT (SGPT)
Phosphatase, alkaline (serum)
Coagulation Tests
aPTT
Bleeding time (Ivy)
INR
Prothrombin time (PT)
Thrombin time (plasma)
Partial thromboplastin time (PTT)
Lipid Profile
High density lipoproteins (HDL)
Triglycerides
Low density lipoproteins (LDL)
(recommended range)
Cholesterol (serum)
Serum Electrolytes
Sodium (serum or plasma)
Potassium (serum)
Chloride (serum)
Calcium (serum)
Magnesium (serum)

24. Iron (serum)
Bicarbonate (HCO3) (serum)
Phosphate
Blood Gases
pCO2 (arterial)
pH (arterial)
pO2 (arterial)
Hormones
Thyroid-stimulating hormone (TSH)
Thyroxine, total (T4) (serum)
Thyroxine, free (FT4) (serum)
Triiodothyronine, total (T3) (serum)
Triiodothyronine, free (FT3) (serum)
Parathyroid hormone (PTH)
Prostate specific antigen (PSA)
Renal Function Tests
Creatinine (serum)
Urea (plasma or serum)
Urea nitrogen (BUN)
Uric acid (serum)
Urine Tests
Protein (urine)
Specific gravity
RBCs
Puss Cells

25. Color
pH
Medication History:
S.NoDrug Prescribed DoseFrequencyCalculated
dose
Justification of drug

26. Comments and Notes
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27. Rationale of Therapy
Case #: _______ Diagnosis: ____________________ Gender: M/F Age: __________
Major Lab Deviations:
1.__________________________________
2.__________________________________
3.__________________________________
4.__________________________________
5.__________________________________
6.__________________________________
S. No
Medication as ordered:
Name/Class/Dose
Normal dose range.
Safe dose?
Action of drug
1. Therapeutic effects
expected
2. Why is patient
receiving med?
1. Adverse reaction /
side effects possible
2. Patient teaching
3. Patient’s response to
Med
1.

28. 2.
3.
4.
5.

29. 6.
7.
8.
9.

31. Performa for DRPs among Statin Users
1)Demographic Information:
Patient Name: ____________________
Age: ____________
Gender: ____________
Length of Hospital stay: ___________ Days
2)Objective:
Lab Reports:
Variable assessed
(mg/dl)
Normal Range
(mg/dl)
Result
(mg/dl)
Comments
Serum Cholesterol< 200 mg/dl
Serum Triglyceride< 150 mg/dl
Serum HDL > 60 mg/dl
Serum LDL < 130 mg/dl
Serum VLDL < 30 mg/dl
3)Statins Prescribed:
Brand Name Generic Name Dose Regimen
4)Other Lipid Lowering Drugs (If any):
Brand Name Generic Name Dose Regimen
5)Drug Related Problems (DRPs):

32. DRPs Presence or Absence of
DRPs
Reason
Drug Overdose
Drug Underdose
Incorrect Route of
Administration
Duplicate Therapy
Drug Contraindication
Drug Therapy failure
Adverse Drug Reaction
No clear indication of
Drug Prescribed
Drug-Drug InteractionsSeverityPresence or
Absence
Minor
Moderate
Major
1)Demographic Information:
Patient Identification Number:
Age (In years):
Gender: Male ☐ Female ☐
Marital status: Single ☐Married ☐ Divorced ☐ Widowed ☐
2)Diagnosis: _________________
3)Concurrent disease/ Comorbidities:
________________________________________
4)Past medical history:
Past medication history ☐ Medication record☐ Patient
Drug name Dose Frequency Comments
Drug Related Problems

34. 5)Present medical history:
Medicine & dose Indication Duration Comments
(6) Evaluation of DRPs:
I.Did the patient have any DRP?
☐Yes ☐ No
If yes, please elaborate by filling the secton below. If no, the following sections donot apply.
II.Classifications: Please classify the DRPs in the categories provided below. Please
justy by providing a comment. Also state the medicine involved and therapeutic
category to which it belongs.
Classification Comment Medicine involvedTherapeutic
category
☐Improper Drug
Selection
☐Failure To
Receive Drug (Non-
Compliance)

35. ☐Overdosage
☐Sub-Therapeutic
Dosage
☐Indication Without
Drug
☐Drug Without
Indication
☐Drug Interaction
☐Adverse Drug
Reaction

36. Causes o f p r o b l e m s: (maximum three boxes to
be tick)
[C1] Drug selection
☐Inappropriate drug
☐No indication for drug
☐Inappropriate combination of drugs or food
(including drug interaction)
☐Inappropriateduplicationoftherapeutic
groups or active ingredient
☐Toomanydrugsprescribedforsame
indication
☐Most cost-effective drug available
☐Synergistic/preventive drug required and not
given
☐New indication of drug treatment presented
☐Unnoticed indication
[C2] Inappropriate drug form:
☐inappropriate drug form
[C3] Dose selection:
☐Drug dose too low
☐Drug dose too high
☐Drug concentration too low
☐Drug concentration too high
☐Dosage regimen too frequent
☐Dosage regimen not frequent
☐No therapeutic drug monitoring
☐PK problems requiring dose adjustment
☐Dose difficulty to measure for administration
[C4] Treatment duration
☐Treatment duration too short
☐Treatment duration too long
[C5] Medication error
☐prescribing error
☐Dispensing error
☐Inappropriate timing of administration or
dosing interval
☐Drug administered to the wrong patient
☐Wrong drug administered
☐Drug not administered at all
☐Drug administered at wrong time
☐Drug abuse
[C6] Drug supply and procurement
☐Prescribed drug not available
[C7] Patient factor
☐Refuse to take the drug
☐Forget to take drug
☐Unable to use drug as prescribed
☐Uses unnecessary drug
☐Takes food/own drug that is suspected to
interact with the drug
[C8] Other causes
☐Unwanted drug side effect
☐prescriber unsure of dosage regimen
☐prescriber unsure of treatment duration
☐Illegible hand writing or inappropriate
abbreviation
☐Poor documentation of drug history
☐Other unspecified